Study Links Puberty Suppression Medication to Decreased Suicide Attempts Among Transgender Adults

A new study published in the journal Pediatrics found that transgender adults who had access to medication during adolescence that suppresses puberty had lower odds of experiencing suicidal ideation than their peers who wanted the treatment but were unable to access it.

The study, titled “Pubertal Suppression for Transgender Youth and Risk of Suicidal Ideation,” is the first to examine associations between access to pubertal suppression and suicidality.

Study at a Glance

• Treatment with pubertal suppression—a noninvasive, reversible process that causes fewer puberty-stimulating hormones to be released during adolescence—was associated with lower odds of lifetime suicidal ideation
• In the study, 90.2% of transgender adults unable to access pubertal suppression experienced suicidal ideation compared with 75.3% of transgender adults treated with pubertal suppression during adolescence
• Only 16.9% of transgender adults in this study reported ever wanting pubertal suppression—this supports the idea that a person’s gender identity is highly personal, and there is a range of desires regarding gender-affirming medical care
• Only 2.5% of transgender adults in this study who wanted pubertal suppression during adolescence received it—this finding shows that access to gender-affirming medical care remains limited despite international guidelines on gender-affirming medical interventions for transgender youth and growing evidence of their potential benefits
• Access to pubertal suppression was associated with a greater total household income—this may be related to the high costs of treatment when not covered by health care insurance, costs that can range from $4,000 to $25,000

“This study adds to the growing evidence base suggesting that gender-affirming medical care for transgender youth is associated with superior mental health outcomes in adulthood,” said Jack L. Turban, MD, resident psychiatrist at Massachusetts General Hospital and McLean Hospital and lead author of the study. “It certainly argues against the misguided notion that gender-affirming care is inherently harmful and should be legislatively banned.”

Findings from the study support treatment recommendations from The Endocrine Society and The World Professional Association for Transgender Health.

Study results also track with recent research from the same group showing that attempts to change a person’s gender identity from transgender to cisgender (sometimes called “conversion efforts” or “conversion therapy”) are associated with poor mental health outcomes, including suicide attempts.

“Transgender adolescents who receive medication that suppresses pubertal development are able to explore gender identities without the dysphoria that often accompanies physical development incongruent with who they are,” stated Alex Keuroghlian, MD, MPH, the study’s senior author.

Keuroghlian, director of the National LGBT Health Education Center at The Fenway Institute and the Massachusetts General Hospital Psychiatry Gender Identity Program, explained that “pubertal suppression therapy is notable among gender-affirming medical interventions in that it is fully reversible. The next step after pubertal suppression is typically gender-affirming hormone therapy so puberty can align with the adolescent’s gender identity.”

The study was authored by researchers at The Fenway Institute, Massachusetts General Hospital, McLean Hospital, and Boston Children’s Hospital. The study’s sample size of 20,619 individuals included residents of all 50 states, the District of Columbia, American Samoa, Guam, Puerto Rico, and U.S. military bases overseas.